Each Thursday, the Daily Voice will showcase selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, residents and alumni of the Department of Family Medicine & Community Health. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more: www.umassmed.edu/news/news-archives/2011/01/Personal-stories-capture-medicines-highs-and-lows/
Warren Ferguson, MD, associate professor of family medicine & community health, writes about a poignant reminder to stay tuned in to a holistic approach to problem solving.
Mr. M is an impressive looking man. He is 6 foot 2 with chiseled facial features and dresses impeccably in a suit coat and tie for his medical appointments. He stands tall and fit, greeting me with a sturdy handshake, with his smile and personality filling up the room. He is 82 years young and could easily pass for 70. When you meet him, it’s impossible not to imagine him as a leader of something, perhaps a mayor or a college dean. He walks an hour a day, rain or shine, and takes pride in keeping his diabetes and high blood pressure under control.
A year ago, he walked in and I quickly got worried. His diabetes was out of control, he’d lost 20 pounds and he felt weak. My knee-jerk reaction was that he must have a malignancy. To my surprise and relief, I diagnosed him with hyperthyroidism. We efficiently got that under control and then we had some tricky care coordination to consider as he was returning to Albania for a three month visit. He was able to get plugged into care in Albania and returned to his former good health. I felt a great deal of satisfaction that everything went so well, wondering if it’s how a surgeon feels after he brings someone back to health after a complicated abdominal infection. When he returned from Albania, he presented a bottle of expensive cognac. I flushed with embarrassment as he showered me with praise, all the while beaming and gesticulating while Teuta interpreted.
Roll forward to two months ago and it was like a déjà vu. He walked in to the office after a few months in Albania, appearing defeated. His weight had plummeted while his blood sugar was running in the 200s. I immediately presumed that his hyperthyroid state was to blame, ordered the tests and was prepared to make the necessary adjustments. Surprise! While I confirmed that his diabetes was out of control, his thyroid was fine. The worry about cancer then loomed large. I squeezed him in the following week and then the diagnosis unfolded.
Mr. M and his wife sat in the exam room, both appearing stoic but a bit forlorn. I asked him if he had changed his eating habits. No. Any signs of infection? No. Was he exercising? Yes, but not so much. Then, the clue came. He and his wife had been having a lot of worries. I asked them to tell me more. They had received an urgent call from Albania that the furniture from their home of 60 years was out on the street in front of their home. They booked an urgent flight and quickly learned that someone had claimed their home as his own and had sold it to another family. They stayed in a hotel and they felt desperate. Mr. M was running all over town, going back and forth to the town hall, the police, getting an attorney and uncovering likely corruption of government officials. Their home and their connection to a life left behind when they came to the United States had been altered.
The emotional toll was devastating. Sleepless nights, sadness, crying and rage came back with them to Worcester. Yet, with my biomedical blinders set firmly over my eyes, I had missed all the cues during the first visit. Now, with their grief and trauma having abated a bit, they told their story with the fervent passion seen in people experiencing PTSD. I listened, empathized and could only imagine the impact of losing their anchor to their home country, not to mention their belongings linking them to their past. It was not the first time and won’t be the last that I’ve seen diabetic control go to hell with emotional upheaval. It was also neither the first nor the last time that I was humbled by the reminder to stay tuned in to a holistic, biopsychosocial approach to problem solving.